Remote Clinical Review Pharmacist

Remote Clinical Pharmacist – Medicare UM

Job Summary

We are seeking a Remote Clinical Pharmacist to review Medicare utilization management requests, including prior authorizations, formulary exceptions, step therapy, and quantity limits. This role focuses on applying clinical criteria to approve or deny medication coverage and is ideal for pharmacists looking to move away from retail pharmacy into a clinical, work‑from‑home role.

Key Responsibilities

• Review Medicare prior authorization and formulary exception requests
• Apply client‑specific clinical criteria to make approval or denial decisions
• Use independent clinical judgment while following established guidelines
• Communicate with providers or members regarding coverage decisions
• Document decisions accurately and maintain high quality standards
• Meet productivity and accuracy metrics (95% quality target)
• Collaborate virtually with pharmacists and supervisors

Must‑Have Requirements

• PharmD or Bachelor of Science in Pharmacy
• Active U.S. pharmacist license in good standing (any state)
• 2 years of pharmacist experience (retail preferred)
• Strong clinical decision‑making skills
• Comfortable working independently in a metrics‑driven environment
• Proficient with computers, multiple systems, and Microsoft Word/Excel
• Typing speed of 45 WPM

Work Environment

• 100% Remote (U.S. only)
• Cannot live in California, Hawaii, or Virginia
• Training 11 weeks with no time off permitted
• Full‑time schedule with possible overtime during peak season
• Rotating weekend and holiday coverage

Why Consider This Role

• Fully remote, non‑retail pharmacist position
• Entry point into PBM / managed care pharmacy
• Medicare experience with long‑term career growth potential
• Contract role with potential for extension or conversion

This is a Contract position based out of Omaha, NE.

The pay range for this position is $55.00 - $55.00/hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:
• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

This is a fully remote position.

This position is anticipated to close on Jun 1, 2026.

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.

San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.

Salary : $55